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beneficiary__add.tpl
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{include file="header.tpl" title="Add Beneficiary" nav="beneficiaries"}
<div>
<h2 class="page-header">Add beneficiary</h2>
<hr />
</div>
<div>
{include file="_partials/success.tpl"}
{include file="_partials/errors.tpl"}
{literal}
<script>
var banks = {
{/literal}
{foreach $banks item=row}
'{$row.id}': '{$row.default_branch_code|string_format:"%06d"}',
{/foreach}
{literal}
};
</script>
{/literal}
<form method="post" class="form-horizontal" role="form">{*data-remote="true">
*}
<input name="utf8" type="hidden" value="✓" />
{include file="_partials/csrf.tpl"}
<div class="form-group">
<label for="inputName" class="col-sm-2 control-label">Beneficiary Name</label>
<div class="col-sm-10">
<input type="text" name="name" class="form-control" id="inputName" placeholder="Beneficiary Name"{if isset($name)} value="{$name|escape}"{/if}>
</div>
</div>
<div class="form-group">
<label for="inputBank3" class="col-sm-2 control-label">Bank</label>
<div class="col-sm-10">
<select name="bank" class="form-control" id="inputBank">
<option value="">Select Bank</option>
{foreach $banks item=row}
<option value="{$row.id}"{if isset($bank) && $bank == $row.id} selected{/if}>{$row.bank_name} ({$row.default_branch_code|string_format:"%06d"})</option>
{/foreach}
</select>
</div>
</div>
<div class="form-group">
<label for="inputAccount Number3" class="col-sm-2 control-label">Account Number</label>
<div class="col-sm-10">
<input type="text" name="account_number" class="form-control" id="inputAccountNumber" placeholder="Account Number"{if isset($account_number)} value="{$account_number|escape}"{/if}>
</div>
</div>
<div class="form-group">
<label for="inputBranchCode" class="col-sm-2 control-label">Branch Code</label>
<div class="col-sm-10">
<input type="text" name="branch_code" class="form-control" id="inputBranchCode" placeholder="Branch Code"{if isset($branch_code)} value="{$branch_code|escape}"{/if}>
</div>
</div>
<div class="form-group">
<label for="inputAccountType" class="col-sm-2 control-label">Account Type</label>
<div class="col-sm-10">
<select name="account_type" class="form-control" id="inputAccountType">
<option value="1"{if isset($account_type) && 1 == $account_type} selected{/if}>Current / Cheque Account</option>
<option value="2"{if isset($account_type) && 2 == $account_type} selected{/if}>Savings account</option>
<option value="3"{if isset($account_type) && 3 == $account_type} selected{/if}>Transmission account</option>
</select>
</div>
</div>
<div class="form-group">
<label for="inputYourReference" class="col-sm-2 control-label">Your Reference</label>
<div class="col-sm-10">
<input type="text" name="reference1" class="form-control" id="inputYourReference" placeholder="Your Reference"{if isset($reference1)} value="{$reference1|escape}"{/if}>
</div>
</div>
<div class="form-group">
<label for="inputTheirReference" class="col-sm-2 control-label">Their Reference</label>
<div class="col-sm-10">
<input type="text" name="reference2" class="form-control" id="inputTheirReference" placeholder="Their Reference"{if isset($reference2)} value="{$reference2|escape}"{/if}>
</div>
</div>
<div class="form-group">
<label for="inputNotificationEmail" class="col-sm-2 control-label">Notification Email Address</label>
<div class="col-sm-10">
<input type="text" name="notification_email_address" class="form-control" id="inputNotificationEmail" placeholder="Notification Email Address"{if isset($notification_email_address)} value="{$notification_email_address|escape}"{/if}>
</div>
</div>
<div class="form-group">
<label for="inputNotificationMobileNumber" class="col-sm-2 control-label">Notification SMS Phone Number</label>
<div class="col-sm-10">
<input type="text" name="notification_mobile_number" class="form-control" id="inputNotificationMobileNumber" placeholder="Notification SMS Phone Number"{if isset($notification_mobile_number)} value="{$notification_mobile_number|escape}"{/if}>
</div>
</div>
<div class="form-group">
<div class="col-sm-offset-2 col-sm-10">
<input data-disable-with="Processing ..." type="submit" class="btn btn-primary" value="Add Beneficiary">
</div>
</div>
</form>
</div>
{include file="footer.tpl"}